• Health Policy and Management
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• 제20권2호
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• pp.40-52
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• 2010

Health insurance fees are set by relative value scales and conversion factors. Since 2008 the conversion factor has been classified into 7 according to the provider type, and a separate contract has been made respectively. As such classification of the conversion factor reflects only the different characteristics of providers, however, further classification to reflect the different cost structures of providers is proposed. Cost varies according to the type of not only providers but also services each provider supply. In fact different cost structures of providers are the result of their different services. This study analyzed the cost structure of medical services to propose a new approach to the classification of the conversion factor. This study analyzed the cost structure of medical services using cost data constructed in the revision study of relative value scales. The cost data consist of doctor's fee, support staff's fee, cost of medical equipments, cost of medical supplies and indirect cost. The proportion of each cost component to the total cost was analyzed in terms of service department and service type. 72 service groups are defined in terms of the combination of service department and service type. Through cluster analysis, 72 service groups were reduced into 7 clusters each of which has a similar cost structure. Conversion factor is contracted annually to reflect the change in the cost of providing medical services. So the classification of conversion factor has to be based on the cost structures of medical services, not the characteristics of providers. Service clusters derived in this study can be used as a new classification for health insurance fee contract.

• The Korean Society of Law and Medicine
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• 제23권2호
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• pp.141-169
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• 2022

Article 34 of 'Medical Service Act' of Korea provides telemedicine service between medical personnel. Telemedicine between medical personnel and patients, therefor, in principle, is not recongnized. Increasing demand for telemedicine fueled by COVID-19 pandemic and accumulation of telemedicine experience lead a change in stubborn opposition of the medical community, tenuous though it may be. This article focuses on the telemedicine legislation in France, which can be used as a reference for the telemedicine legislation premised on telemedicine between medical personnel and patients. The legislation stipulates the concept, types, and conditions of telemedicine performance through 'Code de la santé publique'. The principle that telemedicine shall be performed alternately with direct medical treatment to a patient and details relating to such telemedicine performance as telemedicine costs, medical fees, and telemedicine equipment support are stipulated through an agreement between the medical community and health insurance organizations. From this point, the implications for our legal system were presented.

• Environmental Analysis Health and Toxicology
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• 제30권sup호
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• pp.6.1-6.4
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• 2015

Objectives This study is conducted to estimate the cost paid by the public suffering from disease possibly caused by chemical and to examine the effect on public health. Methods Cost-benefit analysis is an important factor in analysis and decision-making and is an important policy decision tool in many countries. Cost-of-illness (COI), a kind of scale-based analysis method, estimates the potential value lost as a result of illness as a monetary unit and calculates the cost in terms of direct, indirect and psychological costs. This study estimates direct medical costs, transportation fees for hospitalization and outpatient treatment, and nursing fees through a number of patients suffering from disease caused by chemicals in order to analyze COI, taking into account the cost of productivity loss as an indirect cost. Results The total yearly cost of the diseases studied in 2012 is calculated as 77 million Korean won (KRW) per person. The direct and indirect costs being 52 million KRW and 23 million KRW, respectively. Within the total cost of illness, mental and behavioral disability costs amounted to 16 million KRW, relevant blood immunological parameters costs were 7.4 million KRW, and disease of the nervous system costs were 6.7 million KRW. Conclusions This study reports on a survey conducted by experts regarding diseases possibly caused by chemicals and estimates the cost for the general public. The results can be used to formulate a basic report for a social-economic evaluation of the permitted use of chemicals and limits of usage.

• Journal of Korean Clinical Nursing Research
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• 제28권2호
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• pp.122-136
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• 2022

Purpose: This study attempted to recommend a revision of inpatient nursing fees based on analyzing current and appropriate staffing levels. Methods: Staffing grades and their inpatient nursing fees as of the first quarter of 2022 were analyzed. Nurse managers and staff nurses answered surveys about the current and appropriate staffing levels, working days, and monthly salary. A total of 101 nurse managers and 588 staff nurses working in general wards at tertiary hospitals and general hospitals participated in the study. Results: The results showed that grade 1 staffing was found in 73.3% of tertiary hospitals and 63.7% of general hospitals. The current staffing ratios of tertiary hospitals and general hospitals were 1:9.3 and 1:10.4, respectively. The appropriate staffing ratios according to nurse managers and staff nurses at tertiary hospitals were 1:7.6 and 1:7.0, respectively, and 1:8.7 and 1:8.8 in general hospitals, respectively. The average estimated annual working days of staff nurses were 235.2 days in tertiary hospitals and 240.0 days in general hospitals. The median monthly salary for staff nurses was 4.957 million won in tertiary hospitals and 4.140 million won in general hospitals. The new staffing grade system was suggested from 1:6 (Grade 1) to 1:12 (Grade 5). The new inpatient nursing fee schedules were recommended to be paid based on nursing hours per patient day of each grade. Conclusion: The new staffing grade and inpatient nursing fee schedules are expected to increase staffing levels, improve the quality of nursing care, and provide a better work environment for nurses.

• Health Policy and Management
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• 제9권1호
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• pp.156-177
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• 1999

The current method of rate adjustment for inflation is based on the evaluation of the financial performance of hospitals. The method has the disadvantage such as too complicated, expensive process as well as low reliability. This study, therefore, develops the 'Korean Medical Insurance Economic Index(MIEI)' as a new model for the rate adjustment with the use of the macro economic indices. In addition, we calculate the 1992∼1998 rate adjustment with the MIEI, and examines the validity of the MIEI by comparing with the conventional method. Medical costs are classified into nine categories : physician salaries, nurse·pharmacist·medical technician salaries, assistants & others salaries, material cost(by imports), material cost(by domestics), depreciation & rent paid(by imports), depreciation & rent paid(by domestics), power utilities, other administrative costs. Then the category weight which is the ratio of category in the total cost is calculated. Macro economic indices are selected for each cost category in order to reflect the concept of the each cost category and inflation during the year of 1992∼1998. Finally MIEI which integrate all category according to the category weight and selected macro indices is calculated. The mean of hospital MIEI which weighting by amount paid by insurers was cacluated. The result from the application of empirical data to the MIEI model is very similar to that of the current method. Furthermore, this method is very simple and also easy to get social consensus. This MIEI model can be replaced the current method based on the analysis of the financial performance for the adjustment of medical fees.

• The Journal of Korean Medicine
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• 제30권4호
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• pp.64-78
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• 2009

Objectives: To research Korean oriental medical doctors' use of uninsured herbal extracts and how to bring about the insurance coverage of such herbal extracts. Methods: We surveyed Korean oriental doctors about the following issues from October 17th to November 15th, 2008: (1) Korean oriental medical doctors' knowledge about herbal extract insurance and the circumstances of oriental medicine in Korea, (2) their opinion on the coverage of currently uninsured herbal extracts and the dispensing of herbal extracts from pharmacies rather than from their clinics, (3) their use of herbal extracts, and (4) how to bring about insurance coverage of uninsured herbal extracts. Results: Over 70% of the respondents said that herbal medicine prescriptions have been reduced recently and that the existence of herbal medicine is in danger. In addition, 63.64% respondents agreed with expanding insurance coverage to include currently uninsured herbal extracts in spite of the fact that patients might have to obtain herbal extracts from pharmacies rather than from Korean oriental medical clinics. The average patient number per month of uninsured herbal extracts was 13.64 people, the average dosage was 5.64g, the average cost per day was 3,859 won, and the average prescription period was 2.65 days. Korean oriental medical doctors asked an average of 12,486 won for the medical examination-prescription fee and 3,292 won in fees for prescriptions obtained outside the hospital. If insurance coverage expands to include these herbal extracts, their usage is expected to increase 2.31 times. Conclusions: This study shows Korean oriental medical doctors' use of herbal extracts and their opinions about execution of herbal extracts' insurance. A periodic study such as this one will hopefully aid in establishing polices for uninsured herbal extracts' insurance.

• Journal of Korean Academy of Nursing Administration
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• 제5권3호
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• pp.547-561
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• 1999

The purpose of this study was to determine which nursing activities are performed for patients in each of the nine KDRGs and to examine common nursing activities between patients with the nine KDRGs and special nursing activities which were not common to patients with the nine KDRGs. The study will provide basic data for estimation of nursing fees. The nine KDRGs in model project are Lens procedures, tonsillectomy, &/or adenoidectomy, appendectomy &/or not complicate principal diagnosis, vaginal delivery, cesarean section, anal & stomal procedures, inguinal & femoral hernia, uterine & adneza procedure for nonmalignancy, and simple pneumonia & pleurisy. To determine the nursing activities for each of the nine KDRG, checklists of nursing activities in each nine KDRG were developed from the literature and a total of 115 records of patients 'who were diagnosed and discharged between January and April, 1999 from a tertiary medical center. Nursing activities for each of the nine KDRG were verified through two consecutive content analyses. The results of study are followed as: 1. The checklists of nursing activities developed included direct and indirect nursing activities, for a total of 241 nursing activities. Direct nursing consisted of physical, educational, emotional-socioecomomic-spiritual nursing in 17 areas. Indirect nursing had four areas. 2. Through the two consecutive content analyses, 197 nursing activities were selected, having item CVIs of .83 or more. Those included 81 nursing activities for Lens procedures, 95 for Tonsillectomy &/or Adenoidectomy. 93 in Appendectomy &/or not complicated principal diagnosis, 155 for vaginal delivery, 172 for cesarean section, 89 for anal & stomal procedures, 93 for inguinal & femoral hernia, 108 for uterine & adneza procedures for non-malignancy, and 68 for simple pneumonia & pleurisy. 3. Nursing activities for each of the nine KDRG were compared. Activities with 80% or higher commonality within the nine KDRGs consisted of 86 of 197 nursing activities for the total designated common nursing activities, 30 common nursing activities for patients in the operation group, 45 common activities for patients in the delivery Group. Special nursing activities not common within the nine KDRGs were : 3 for Lens procedures, 1 for Tonsillectomy &/or Adenoidectomy. 2 for Appendectomy &/or not complicated principal diagnosis, 27 for vaginal delivery, 21 for Cesarean section, 6 for anal & stomal procedures, 3 for inguinal & femoral hernia, 16 for uterine & adneza procedure for non-malignancy, 8 for simple pneumonia & pleurisy. In this study, nursing activities for each of the nine KDRGs verified through two consecutive content analyses are those that are performed in the hospital. And, nursing activities for each of the nine KDRGs included all nursing activities from hospital admission to discharge. So. the checklists consisted of nursing activities that allow for an estimation of nursing fees under PPS. The classification of nursing activities in the study will provide a reference for the development of a nursing activity classification.

• Health Policy and Management
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• 제25권1호
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• pp.11-21
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• 2015

Background: The objective of this research is to investigate and provide analysis of the economic participatory change affecting the unmet needs of health care in Korean adults. Methods: We used Korea health panel 4th and 5th data of 10,261 adults. The method of investigation is threefold. First, We identified the regional factors affecting unmet needs of health care. Second, we analyzed the effect of economic participatory change as it affects the unmet needs of health care. Third, we also investigated whether there were discernable differences between the age subgroups. Results: It was determined that influencing factors included sex, education, economic level, and health status. And after the subgroup analysis of age, we found that the economic participatory change was associated with the economical unmet needs of health care especially for those over 40 years of age. Also the population are facing unemployment enduring particular economic hardship in meeting their medical needs. Conclusion: This study finds that there are some policy recommendations for the sake of medical service equality. Medical welfare policy for those 40 years of age and older has been identified as an area that needs improvement. And considering that those 40 years of age and older are facing unemployment enduring particular economic hardship in meeting their medical needs, this study finds a need for government sponsored medical stipends or subsidizing of medical premiums, co-payment, and other fees.

• Journal of Preventive Medicine and Public Health
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• 제39권3호
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• pp.185-189
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• 2006

It is the actual state of the medical society in our country that many graduates of medical schools want to be clinicians, and accordingly Korea's medical situation is relatively too focused on curative medicine. However, this situation is changing due to several factors including a growing number of doctors, inappropriate regulations for medical fees, changes in social status of doctors themselves, and excessive competition between doctors. Furthermore, we expect more advances in medical field of Korea since Korean government started to attach great importance to sciences and produced policies to support sciences, and as a result, more and more interest and effort in the fields of basic research including preventive medicine is being attached especially by young doctors as compared against the past. However, decline of clinical medicine fields doesn't always mean bright future for the field of preventive medicine. True future is possible and meaningful only when we prepare for it by ourselves. In other words, as the promising future is closed to one who spares no effort, we shouldn't fear to oppose unknown challenges and simultaneously need to support colleagues who bear such a positive mind. It is the most important thing for our preventive medicine doctors to evaluate the past and the present of preventive medicine and to foster a prospective mind to prepare for the future of preventive medicine. I set forth my several views according to directions for the development of preventive medicine which we already discussed and publicized in the academic circle of preventive medicine. Those directions are recommendation of clinical preventive medicine, promotion of preventive medicine specialty, fostering the next generations, improving the quality of genetic epidemiologic study, participation in control of environmental pollution and food safety, contribution to chronic disease control, and preparation to role in medical services for unified Korea.

• Research in Community and Public Health Nursing
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• 제33권4호
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• pp.357-371
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• 2022

Purpose: This study aims to investigate factors related to long-term length of stay (LOS) of patients with chronic diseases in Korean veterans hospitals. Methods: The subjects were 196 elderly patients with chronic disease staying in the hospital for more than 10 days, Data were collected by the survey of patients with structured questionnaires and medical records review by nurses from July 15 to August 10, 2019. Collected data were analyzed using t-test, ANOVA, Pearson's correlation coefficient and stepwise multiple regression. Results: The present and desired LOS were 37.78±32.66 days and 60.87±45.95 days, respectively. Factors affecting hospital LOS were found to be main disease (genitourinary) (p<.001), assistance in activities of daily living (p<.001), area of hospital (p<.001), payment of medical fees (p=.026), hospital satisfaction (p=.036) and the explanatory power of these variables was 26.4%. The most common health problems that need to be solved after discharge were symptom alleviation and health promotion. These problems can be solved using community-based facility services or visiting medical-welfare services (especially home care nursing). Conclusion: In order to reduce hospital LOS, the following measures are required: personalized self-management education, provision of transportation services for dialysis therapy of inactive patients, linking patients with visiting medical-welfare services including home care nursing and mobile healthcare services, operation of the case management system including the notice of the discharge date at admission, interim check of patient status, and connecting the patient with community resources or transferring the patient to long-term care facilities at discharge.